Monitoring food and health news -- with particular attention to fads, fallacies and the "obesity" war

Summary of findings to date: Everything you can possibly eat or drink is both bad and good for you

"Let me have men about me that are fat... Yond Cassius has a lean and hungry look ... such men are dangerous." -- Shakespeare

Friday, December 15, 2006

Maccas puts gyms on children's menu

Good capitalism: Anything to keep the customers happy

US fast-food giant McDonald's, often accused of catering to expanding waistlines, has a new item on its menu for kids - gyms. The company is testing R Gyms - in-restaurant mini-gyms with stationary bicycles hooked to video games, obstacle courses and aerobics exercises - in seven of its restaurants to help customers age 4 to 12 fight flab as they ingest calories. The latest R Gym, named for the restaurant's advertising mascot Ronald McDonald, opened in California earlier this month and the company is hoping to spread the concept across the United States and possibly overseas.

But critics say the mini-gyms are merely an attempt by the burger giant to polish its image at a time when people are increasingly aware of the health hazards linked to obesity. "What we've been able to do with the R Gym is to provide our youngest customers with a more relevant contemporary experience, including games and activities that are more suitable to children's lifestyles today and of course tomorrow," Danya Proud, a spokeswoman for McDonald's said.

The experts are skeptical. "The number of calories that a child is likely to burn in one of those gyms is quite small compared to what they can eat, even in a small meal," said Kelly Brownell, director of the Rudd Centre for Food Policy and Obesity at Yale University. It would take a child, for example, more than three hours of exercise to burn off a 200-calorie milkshake.

The new gyms would eventually replace play areas currently available in some 5500 McDonald's outlets throughout the country. McDonald's is also considering R Gyms for its restaurants overseas.

But specialists like Prof Brownell warn the gyms could have an adverse effect in that they could lull people into believing they can eat more since they're exercising. "One risk is that the children or parents overestimate how much benefit they are getting from the exercise and feel licensed to eat more - a larger order of French fries or an ice cream cone," he said.

Ms Proud answers such criticism by saying that McDonald's has "always been concerned about health". "McDonald's has been providing nutritious menu options to all of our customers for 52-plus years," she said.

According to health experts, about one-third of children in the United States are either overweight or obese and trends are showing the numbers increasing. Studies have also said one in five Australian children is overweight or obese, with the figure set to expand to one in two by 2020, according to some predictions. The US Centres for Disease Control and Prevention (CDC) recently identified fast food as a significant factor in that country's obesity epidemic. According to the CDC, nearly 19 per cent of American children between the ages of 6 and 11 are overweight and some 14 per cent are in that category before the age of 5.

Prof Brownell said with that in mind, McDonald's R Gyms could be an attempt by the company to ward off class-action lawsuits from public-health advocates who see fast food as their new target after tobacco. "McDonald's is not in the business of getting the population more physically active but if they appear to be on the right side of the issue, they may be able to forestall litigation, legislation that hurts them and just bad public opinion in general," he said.

In medicine, yesterday's breakthrough technology is today's safety worry. Case in point: the drug coated stents that will be examined at a potentially contentious and controversial session convened today by the Food and Drug Administration. Comprised of many of America's top heart doctors, the group will consider the quandary that has emerged around these tiny tubes of metal mesh, used in a non-invasive alternative to open-heart surgery: Do they help more patients then they hurt?

It's a crucial question. Since Merck pulled its painkiller Vioxx from the two years ago, the drug business has been beset by controversies about the safety of the medicines it makes. The device industry has not been hit as hard by safety concerns--until now. A new focus on the risks of devices, as well as their benefits, could be a big change for companies such as Johnson & Johnson, Boston Scientific and Medtronic.

What the panel will decide after the two-day session in Gaithersburg, Md., is anyone's guess, but it is likely the stents, which generate $5 billion a year in annual sales, will remain on the market with at least some new restrictions on their use. "I don't think it's in the cards that they're going to take them off the market," says Deepak Bhatt, a researcher at the Cleveland Clinic. "They've been studied, and they work very well. But there may be some specific guidance given as to which patients should receive the drug-coated stents."

What could result are new limits on when the devices should be used. Right now, drug-coated stents still account for the vast majority of the market. But some doctors say it may be possible to screen out a third of the patients who receive the newer stents for whom the benefits really don't outweigh the risk, denting sales. Also, the panel could instruct physicians to make sure patients take blood-thinners like Plavix, from Bristol-Myers Squibb and Sanofi-Aventis, for years after the operation if the drug-coated stents are used. A large number of patients don't continue to take their medicine, putting themselves at risk; doctors might want to avoid giving drug-coated stents to people who won't take their pills.

Stents are used to open blockages in coronary arteries caused by the buildup of plaque, which can block blood flow, causing heart attacks and chest pain. The devices have been around for a decade, but these new versions, from Johnson & Johnson and Boston Scientific, are coated with medicines intended to cut down the number of repeat procedures and return trips to the hospital.

The drug-coated stents have been implanted in 4 million patients since Johnson & Johnson launched the first one in 2003. But now it is becoming clear that people who get the devices are more likely to have dangerous blood clots form in the stent, causing the very heart attacks the stents are designed to prevent. Using conservative estimates, the devices might cause 4,000 heart attacks a year.

Defenders say they actually prevent as many heart attacks and deaths as they cause, because all those return trips to the hospital, and the chance of reclosed arteries expose patients to risk. And the risk, they point out, is small for any individual patient. A recent Cleveland Clinic paper put it at one clot per 250 patients each year; analyses of the companies' own clinical trials show a risk of about one in 500 patients per year. The biggest challenge for the experts: There really isn't enough data to draw a conclusion. They are likely to focus on two main questions: who should get the drug-coated devices, as opposed to the older bare-metal stents, and how long do these patients need to take the blood thinner Plavix, which seems to reduce the risk of the dangerous clots.

There may also be controversy about who was included in the expert panel. Bruce Nudell, an analyst at Sanford C. Bernstein, said that some panelists, notably Steven Nissen of the Cleveland Clinic and Eric Topol of Scripps Clinic, the cardiologists who initially drew attention to the dangers of Vioxx, might create "a bit of a hostile air." But Nudell thinks the FDA will not, at the end of the day, aggressively limit the use of either stent. Still, the inclusion of Nissen and Topol has made some Wall Street analysts nervous.

Right now, says Sanjay Kaul of Cedars-Sinai Medical Center, about 60% of use of drug-coated stents does not match up with the clinical studies of the drugs that have been evaluated by the FDA. Speaking conservatively, he says, one would limit the use of the devices to those patients in whom they had been studied. He also says that new trials should be conducted to find out how long patients need to take Plavix and exactly which patients should get the drug-coated stents.

There are also larger questions. Stents are used in a medical procedure called angioplasty, in which a balloon is used to prop open a clogged artery. Sometimes this is done during a heart attack, and at these times the procedure has been shown to save lives. But most angioplasties are done to reduce symptoms of chest pain that come from clogged arteries. Some doctors say many of these patients should be treated with medicine, not surgery.

It used to be said that inside every fat person was a thin person trying to get out. Now it seems it could be other way around. A scanning technique pioneered by British doctors has found that many slim people are storing up dangerous levels of fat in their bodies. Jimmy Bell, head of the molecular imaging group at the Medical Research Council's centre at Imperial College, London, said this hidden fat could trigger heart conditions and diabetes.

"The important message is people shouldn't be happy just because they look thin . You can look healthy but have a lot of fat internally, which can have a detrimental effect on your health."

Professor Bell and his team began using a magnetic resonance imaging scanner to seek internal fat while researching type 2 diabetes - the version of the disease that develops later in life and is normally associated with obesity. His suspicions arose when several slim people in the study were found to have the medical markers for type 2 diabetes.

The findings raise questions about the body mass index, the indicator of obesity used by most doctors and public health campaigners. The index is a relatively crude measure in which a person's weight in kilograms is divided by the square of their height in metres. Some doctors believe the index is flawed because it pays no attention to the nature of the weight. A rugby player, for instance, with heavier than usual muscles, will come out with a high score on the index and could be classified as overweight, even though he has low levels of internal fat.

1). It tries to impose behavior change on everybody -- when most of those targeted are not obese and hence have no reason to change their behaviour. It is a form of punishing the innocent and the guilty alike. (It is also typical of Leftist thinking: Scorning the individual and capable of dealing with large groups only).

2). The longevity research all leads to the conclusion that it is people of MIDDLING weight who live longest -- not slim people. So the "epidemic" of obesity is in fact largely an "epidemic" of living longer.

3). It is total calorie intake that makes you fat -- not where you get your calories. Policies that attack only the source of the calories (e.g. "junk food") without addressing total calorie intake are hence pissing into the wind. People involuntarily deprived of their preferred calorie intake from one source are highly likely to seek and find their calories elsewhere.

4). So-called junk food is perfectly nutritious. A big Mac meal comprises meat, bread, salad and potatoes -- which is a mainstream Western diet. If that is bad then we are all in big trouble.

5). Food warriors demonize salt and fat. But we need a daily salt intake to counter salt-loss through perspiration and the research shows that people on salt-restricted diets die SOONER. And Eskimos eat huge amounts of fat with no apparent ill-effects. And the average home-cooked roast dinner has LOTS of fat. Will we ban roast dinners?

6). The foods restricted are often no more calorific than those permitted -- such as milk and fruit-juice drinks.

7). Tendency to weight is mostly genetic and is therefore not readily susceptible to voluntary behaviour change.

8). And when are we going to ban cheese? Cheese is a concentrated calorie bomb and has lots of that wicked animal fat in it too. Wouldn't we all be better off without it? And what about butter? It is just about pure fat. Surely it should be treated as contraband in kids' lunchboxes! [/sarcasm].

9). For a summary of the weak science behind the "trans-fat" hysteria, see here. Trans fats have only a temporary effect on blood chemistry and no lasting harm from them has ever been shown.

Where it is not bunk is when it shows that some treatment or influence has no effect on lifespan or disease incidence. It is as convincing as disproof as it is unconvincing as proof. Think about it. As Einstein said: No amount of experimentation can ever prove me right; a single experiment can prove me wrong.

Epidemiological studies are useful for hypothesis-generating or for hypothesis-testing of theories already examined in experimental work but they do not enable causative inferences by themselves

The standard of reasoning that one commonly finds in epidemiological journal articles is akin to the following false syllogism:
Chairs have legs
You have legs
So therefore you are a chair

I am rather in despair that important medical research is plagued by arrant nonsense. The simple truth that correlation is not causation seems unknown to most medical writers. As a last ditch attempt to get that truth into a few more skulls let me be "offensive". Offensiveness may serve to get the matter noticed. So here is the story: There is about a -.5 correlation between lip size and IQ. Big lips predict low IQ. Your run-of-the mill medical researcher will pounce on that as a huge breakthrough in finding the causes of IQ -- and propound new theories about things such as blood circulation to explain how lips affect IQ. But that is nonsense. Big lips are mostly found on people of African ancestry and, as all the studies attest, Africans are a very low IQ group. The correlation arises because of heredity, not lip size. There is a third factor behind the correlation -- and the possibility of such third factors seems to be a jaw-dropping surprise to most medical researchers

SALT -- SALT -- SALT

1). A good example of an epidemiological disproof concerns the dreaded salt (NaCl). We are constantly told that we eat too much salt for good health and must cut back our consumption of it. Yet there is one nation that consumes huge amounts of salt. So do they all die young there? Quite the reverse: Japan has the world's highest concentration of centenarians. Taste Japan's favourite sauce -- soy sauce -- if you want to understand Japanese salt consumption. It's almost solid salt.

2). We need a daily salt intake to counter salt-loss through perspiration and the research shows that people on salt-restricted diets die SOONER. So the conventional wisdom is not only wrong. It is positively harmful

3). Table salt is a major source of iodine, which is why salt is normally "iodized" by official decree. Cutting back salt consumption runs the risk of iodine deficiency, with its huge adverse health impacts -- goiter, mental retardation etc. GIVE YOUR BABY PLENTY OF SALTY FOODS -- unless you want to turn it into a cretin

4). Our blood has roughly the same concentration of salt as sea-water so claims that the body cannot handle high levels of salt were always absurd

5). The latest academic study shows that LOW salt in your blood is most likely to lead to heart attacks. See JAMA. 2011;305(17):1777-1785. More here and here and here for similar findings. Salt is harmless but a deficiency of it is not. We need it. See also here

PEANUTS: There is a vaccination against peanut allergy -- peanuts themselves. Give peanut products (e.g. peanut butter -- or the original "Bamba" if you have Israeli contacts) to your baby as soon as it begins to take solid foods and that should immunize it for life. See here and here (scroll down). It's also likely that a mother who eats peanuts while she is lactating may confer some protection on her baby. See here

THE SIDE-EFFECT MANIA. If a drug is shown to have troublesome side-effects, there are always calls for it to be banned or not authorized for use in the first place. But that is insane. ALL drugs have side effects. Even aspirin causes stomach bleeding, for instance -- and paracetamol (acetaminophen) can wreck your liver. If a drug has no side effects, it will have no main effects either. If you want a side-effect-free drug, take a homeopathic remedy. They're just water.

Although I am an atheist, I have never wavered from my view that the New Testament is the best guide to living and I still enjoy reading it. Here is what the apostle Paul says about vegetarians: "For one believeth that he may eat all things: another, who is weak, eateth herbs. Let not him that eateth despise him that eateth not; and let not him which eateth not judge him that eateth." (Romans 14: 2.3). What perfect advice! That is real tolerance: Very different from the dogmatism of the food freaks. Interesting that vegetarianism is such an old compulsion, though.

Even if we concede that getting fat shortens your life, what right has anybody got to question someone's decision to accept that tradeoff for themselves? Such a decision could be just one version of the old idea that it is best to have a short life but a merry one. Even the Bible is supportive of that thinking. See Ecclesiastes 8:15 and Isaiah 22: 13. To deny the right to make such a personal decision is plainly Fascistic.

Obesity does NOT causes diabetes. But insatiable eating is a prominent symptom of diabetes. So diabetes DOES cause obesity, which accounts for the correlation between the two things. The streets are full of fatties who don't have diabetes. How come? If conventional medical theory were correct we should be in the midst of an epidemic of diabetes. A recent high quality study has also found that fatties are LESS likely to die of diabetes

Elite people frequently express disapproval of red meat eating as a way of expressing their felt superiority to the ordinary people who eat it

IQ: Political correctness makes IQ generally unmentionable so it is rarely controlled for in epidemiological studies. This is extremely regrettable as it tends to vitiate findings that do not control for it. When it is examined, it is routinely found to have pervasive effects. We read, for instance, that "The mother's IQ was more highly predictive of breastfeeding status than were her race, education, age, poverty status, smoking, the home environment, or the child's birth weight or birth order". So political correctness can render otherwise interesting findings moot

"To kill an error is as good a service as, and sometimes better than, the establishing of a new truth or fact" -- Charles Darwin

"Most men die of their remedies, not of their diseases", said Moliere. That may no longer be true in general but there is still a lot of false medical "wisdom" around that does harm to various degrees -- the statin and antioxidant fads, for instance. And showing its falsity is rarely the problem. The problem is getting people -- medical researchers in particular -- to abandon their preconceptions

Bertrand Russell could have been talking about today's conventional dietary "wisdom" when he said: "The fact that an opinion has been widely held is no evidence whatever that it is not utterly absurd; indeed in view of the silliness of the majority of mankind, a widespread belief is more likely to be foolish than sensible.”

The challenge, as John Maynard Keynes knew, "lies not so much in developing new ideas as in escaping from old ones".

"Obesity" is 77% genetic. So trying to make fatties slim is punishing them for the way they were born. That sort of thing is furiously condemned in relation to homosexuals so why is it OK for fatties?

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Some more problems with the "Obesity" war:

1). It tries to impose behavior change on everybody -- when most of those targeted are not obese and hence have no reason to change their behaviour. It is a form of punishing the innocent and the guilty alike. (It is also typical of Leftist thinking: Scorning the individual and capable of dealing with large groups only).

2). The longevity research all leads to the conclusion that it is people of MIDDLING weight who live longest -- not slim people. So the "epidemic" of obesity is in fact largely an "epidemic" of living longer.

3). It is total calorie intake that makes you fat -- not where you get your calories. Policies that attack only the source of the calories (e.g. "junk food") without addressing total calorie intake are hence pissing into the wind. People involuntarily deprived of their preferred calorie intake from one source are highly likely to seek and find their calories elsewhere.

4). So-called junk food is perfectly nutritious. A big Mac meal comprises meat, bread, salad and potatoes -- which is a mainstream Western diet. If that is bad then we are all in big trouble.

5). Food warriors demonize dietary fat. But Eskimos living on their traditional diet eat huge amounts of fat with no apparent ill-effects. At any given age they in fact have an exceptionally LOW incidence of cardiovascular disease. And the average home-cooked roast dinner has LOTS of fat. Will we ban roast dinners?

6). The foods restricted are often no more calorific than those permitted -- such as milk and fruit-juice drinks.

7). Tendency to weight is mostly genetic and is therefore not readily susceptible to voluntary behaviour change.

8). And when are we going to ban cheese? Cheese is a concentrated calorie bomb and has lots of that wicked animal fat in it too. Wouldn't we all be better off without it? And what about butter and margarine? They are just about pure fat. Surely they should be treated as contraband in kids' lunchboxes! [/sarcasm].

9). And how odd it is that we never hear of the huge American study which showed that women who eat lots of veggies have an INCREASED risk of stomach cancer? So the official recommendation to eat five lots of veggies every day might just be creating lots of cancer for the future! It's as plausible (i.e. not very) as all the other dietary "wisdom" we read about fat etc.

10). And will "this generation of Western children be the first in history to lead shorter lives than their parents did"? This is another anti-fat scare that emanates from a much-cited editorial in a prominent medical journal that said so. Yet this editorial offered no statistical basis for its opinion -- an opinion that flies directly in the face of the available evidence.

11). A major cause of increasing obesity is certainly the campaign against it -- as dieting usually makes people FATTER. If there were any sincerity to the obesity warriors, they would ban all diet advertising and otherwise shut up about it. Re-authorizing now-banned school playground activities and school outings would help too. But it is so much easier to blame obesity on the evil "multinationals" than it is to blame it on your own restrictions on the natural activities of kids

12. Fascism: "What we should be doing is monitoring children from birth so we can detect any deviations from the norm at an early stage and action can be taken". Who said that? Joe Stalin? Adolf Hitler? Orwell's "Big Brother"? The Spanish Inquisition? Generalissimo Francisco Franco Bahamonde? None of those. It was Dr Colin Waine, chairman of Britain's National Obesity Forum. What a fine fellow!

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Trans fats: For one summary of the weak science behind the "trans-fat" hysteria, see here. Trans fats have only a temporary effect on blood chemistry and the evidence of lasting harm from them is dubious. By taking extreme groups in trans fats intake, some weak association with coronary heart disease has at times been shown in some sub-populations but extreme group studies are inherently at risk of confounding with other factors and are intrinsically of little interest to the average person.

The "antioxidant" religion: The experimental evidence is that antioxidants SHORTEN your life, if anything. Studies here and here and here and here and here and here and here and here, for instance. That they are of benefit is a great theory but it is one that has been coshed by reality plenty of times.

The medical consensus is often wrong. The best known wrongheaded medical orthodoxy is that stomach ulcers could not be caused by bacteria because the stomach is so acidic. Disproof of that view first appeared in 1875 (Yes. 1875) but the falsity of the view was not widely recognized until 1990. Only heroic efforts finally overturned the consensus and led to a cure for stomach ulcers. See
here and here and here.

Dieticians are just modern-day witch-doctors. There is no undergirding in double-blind studies for their usual recommendations

The fragility of current medical wisdom: Would you believe that even Old Testament wisdom can sometimes trump medical wisdom? Note this quote: "Spiess discussed Swedish research on cardiac patients that compared Jehovah's Witnesses who refused blood transfusions to patients with similar disease progression during open-heart surgery. The research found those who refused transfusions had noticeably better survival rates.

Medical wisdom can in fact fly in the face of the known facts. How often do we hear reverent praise for the Mediterranean diet? Yet both Australians and Japanese live longer than Greeks and Italians, despite having very different diets. The traditional Australian diet is in fact about as opposite to the Mediterranean diet as you can get. The reverence for the Mediterranean diet can only be understood therefore as some sort of Anglo-Saxon cultural cringe. It is quite brainless. Why are not the Australian and Japanese diets extolled if health is the matter at issue?

Since many of my posts here make severe criticisms of medical research, I should perhaps point out that I am also a severe critic of much research in my own field of psychology. See here and here

This is NOT an "alternative medicine" site. Perhaps the only (weak) excuse for the poorly substantiated claims that often appear in the medical literature is the even poorer level of substantiation offered in the "alternative" literature.

I used to teach social statistics in a major Australian university and I find medical statistics pretty obfuscatory. They seem uniformly designed to make mountains out of molehills. Many times in the academic literature I have excoriated my colleagues in psychology and sociology for going ga-ga over very weak correlations but what I find in the medical literature makes the findings in the social sciences look positively muscular. In fact, medical findings are almost never reported as correlations -- because to do so would exhibit how laughably trivial they generally are. If (say) 3 individuals in a thousand in a control group had some sort of an adverse outcome versus 4 out of a thousand in a group undergoing some treatment, the difference will be published in the medical literature with great excitement and intimations of its importance. In fact, of course, such small differences are almost certainly random noise and are in any rational calculus unimportant. And statistical significance is little help in determining the importance of a finding. Statistical significance simply tells you that the result was unlikely to be an effect of small sample size. But a statistically significant difference could have been due to any number of other randomly-present factors.

"The modern literature on hate crimes began with a remarkable 1933 book by Arthur Raper titled The Tragedy of Lynching. Raper assembled data on the number of lynchings each year in the South and on the price of an acre's yield of cotton. He calculated the correlation coefficient between the two series at -0.532. In other words, when the economy was doing well, the number of lynchings was lower.... In 2001, Donald Green, Laurence McFalls, and Jennifer Smith published a paper that demolished the alleged connection between economic conditions and lynchings in Raper's data. Raper had the misfortune of stopping his analysis in 1929. After the Great Depression hit, the price of cotton plummeted and economic conditions deteriorated, yet lynchings continued to fall. The correlation disappeared altogether when more years of data were added."

So we must be sure to base our conclusions on ALL the data. But in medical research, data selectivity and the "overlooking" of discordant research findings is epidemic.

The Truth About Ancel Keys. Keys was a brilliant man but his concentration on heart disease misled him. He was right that high fat intake predicted high rates of heart disease (though it was ANIMAL fat in particular that was the "culprit") but he overlooked that the same intake predicted LESS mortality from other causes. The same narrow vision led him to be the earliest prominent advocate of the "Mediterranean diet" hypothesis. It's true that Mediterraneans have less heart disease but they have more of other causes of death, so that Mediterranean countries do not have particularly long lifespans when compared with other developed countries. If there are any lessons about diet to be learned from lifespans, it is un-Mediterranean countries like Australia and the Nordic countries that one should look to.

The intellectual Roman Emperor Marcus Aurelius (AD 121-180) could have been speaking of the prevailing health "wisdom" of today when he said: "The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane."

Improbable events do happen at random -- as mathematician John Brignell notes rather tartly: "Consider, instead, my experiences in the village pub swindle. It is based on the weekly bonus ball in the National Lottery. It so happens that my birth date is 13, so that is the number I always choose. With a few occasional absences abroad I have paid my pound every week for a year and a half, but have never won. Some of my neighbours win frequently; one in three consecutive weeks. Furthermore, I always put in a pound for my wife for her birth date, which is 11. She has never won either. The probability of neither of these numbers coming up in that period is less than 5%, which for an epidemiologist is significant enough to publish a paper.

Kids are not shy anymore. They are "autistic". Autism is a real problem but the rise in its incidence seems likely to be the product of overdiagnosis -- the now common tendency to medicalize almost all problems.

One of the great pleasures in life is the first mouthful of cold beer on a hot day -- and the food Puritans can stick that wherever they like

NOTE: The archives provided by blogspot below are rather inconvenient. They break each month up into small bits. If you want to scan whole months at a time, the backup archives will suit better. See here or here